Palpitations occur when a person becomes aware of their heartbeat. The heartbeat may feel hard, fast, or uneven in their chest.
Symptoms include a very fast or irregular heartbeat. Palpitations are a sensory symptom. However, they may signal a fast or irregular heartbeat. Palpitations can be brief or long-lasting. They can be intermittent or continuous. Other symptoms can include dizziness, shortness of breath, sweating, headaches, and chest pain.
Signs and symptoms
Three common descriptions of palpitation are:
- "flip-flopping" (or "stop and start") is often caused by premature contraction of the atrium or ventricle. The pause after the contraction causes the "stop." The "start" comes from the next forceful contraction.
Palpitations often come with other symptoms. Knowing these links can help determine if they are dangerous or harmless. However, these links are not definitive and should be evaluated by a licensed healthcare provider to ensure an accurate diagnosis and proper care.
Palpitations associated with chest discomfort or chest pain suggests coronary artery disease.
Causes
The responsibility for the perception of heartbeat by neural pathways is not clear. It has been hypothesized that these pathways include different structures located both at the intra-cardiac and extra-cardiac level.
Palpitation can be attributed to one of five main causes:
- Extra-cardiac stimulation of the sympathetic nervous system (inappropriate stimulation of the sympathetic and parasympathetic, particularly the vagus nerve, (which innervates the heart), can be caused by anxiety and stress due to acute or chronic elevations in glucocorticoids and catecholamines.
- Hyperdynamic circulation (valvular incompetence, thyrotoxicosis, hypercapnia, high body temperature, low red blood cell count, pregnancy).
- Abnormal heart rhythms (ectopic beat, premature atrial contraction, junctional escape beat, premature ventricular contraction, atrial fibrillation, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, heart block).
- Pectus Excavatum, also known as funnel chest, is a chest wall deformity. When the breastbone (sternum) and attached ribs are sunken in enough to put excess pressure on the heart and lungs which can cause tachycardia and skipped beats.
Palpitations can occur during times of catecholamine excess, such as during exercise or at times of stress. Gastrointestinal bloating, indigestion and hiccups have also been associated with overstimulation of the vagus nerve causing palpitations, due to branches of the vagus nerve innervating the GI tract, diaphragm, and lungs.
Many psychiatric conditions can result in palpitations including depression, generalized anxiety disorder, panic attacks, and somatization. However one study noted that up to 67% of patients diagnosed with a mental health condition had an underlying arrhythmia.
Excessive consumption of caffeine, commonly found in coffee, tea, and energy drinks, is a well-known trigger. These substances can lead to serious health issues, including vasospasm-related angina, heart attacks, and strokes. Understanding the impact of these substances is crucial for both prevention and management of palpitations.
Pathophysiology
The sensation of palpitations can arise from extra-systoles or tachyarrhythmia. However, these techniques may provide only temporary relief, and if palpitations persist or are associated with other concerning symptoms, medical evaluation is essential to determine any underlying causes and appropriate treatment options. Formal research has found that current smartwatch apps can detect abnormal heart rhythms, like atrial fibrillation and alert people to this. These apps can also detect changes in heart rhythm, like the QT interval, correctly identify these changes in about in a significant majority of people who have them.
thumb|Generic smartwatch with software to monitor cardiac function
Many people worry when they feel palpitations.